Oregon Revised Statutes Chapter 743A

What this document is

Oregon Revised Statutes Chapter 743A - Health Insurance Mandated Benefits (whole chapter, 743A.001-743A.335) is a state statute published by Oregon Legislative Assembly, oregonlegislature.gov. It is one of the Oregon documents that insurance license exam questions are written from, including oregon life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• ORS Chapter 743A § 743A.160 (Alcoholism Treatment)

  “A health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide, at the request of the applicant, coverage for expenses arising from treatment for alcoholism. The following conditions apply to the requirement for such coverage: (1)...”

• ORS Chapter 743A § 743A.168(2)(e) (Behavioral Health Network Adequacy)

  “If there is no in-network provider qualified to timely deliver, as defined by rule, medically necessary behavioral treatment to an insured in a geographic area, the group health insurer or issuer of an individual health benefit plan shall provide coverage of out-of-network medically necessary...”

• ORS Chapter 743A § 743A.084 (Maternity Payments for Unmarried Women and Their Children)

  “Each policy of health insurance shall provide: (1) The same payments for costs of maternity to unmarried women that it provides to married women, including the spouses in marriages of insured persons choosing family coverage; and (2) The same coverage for the child of an unmarried woman that the...”

• ORS Chapter 743A § 743A.062(3) (Prescription Drugs: Specialty Drug Mail Order Exception)

  “Subsection (2)(b)(A) of this section does not prohibit an insurer from requiring a medical assistance recipient to fill or refill a prescription for a specialty drug at a mail order pharmacy that is a specialty pharmacy.”

• ORS Chapter 743A § 743A.169(2)(a) (Same Day or Same Facility Services)

  “An individual or group policy or certificate of health insurance that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, may not: (a) Exclude coverage for a behavioral health...”

• ORS Chapter 743A § 743A.020 (Services Provided by Acupuncturist)

  “An individual or group health insurance policy that provides coverage for acupuncture services performed by a physician shall provide coverage for acupuncture services performed by an acupuncturist licensed under ORS 677.757 to 677.770.”

• ORS Chapter 743A § 743A.001(3) (Automatic Repeal of Certain Mandated Benefit Statutes)

  “A repeal of a statute under subsection (1) of this section does not apply to any insurance policy in effect on the effective date of the repeal. However, the repeal of the statute applies to a renewal or extension of an existing insurance policy on or after the effective date of the repealer as...”

• ORS Chapter 743A § 743A.101 (Supplemental or Diagnostic Breast Examinations)

  “Except as provided in ORS 742.008, a carrier offering a group health benefit plan or an individual health benefit plan in this state that reimburses the cost of supplemental or diagnostic breast examinations may not impose on the coverage of a medically necessary supplemental or diagnostic breast...”

• ORS Chapter 743A § 743A.032 (Surgical Services Provided by Dentist)

  “Notwithstanding any provision of a policy of health insurance, whenever the policy provides for payment of a surgical service, the performance for the insured of such surgical service by any dentist acting within the scope of the dentist’s license is compensable if performance of that service by a...”

• ORS Chapter 743A § 743A.260(2) (Inmates - Prohibited Grounds for Denial)

  “Except as provided in subsection (4) of this section, an insurer offering a health benefit plan may not deny reimbursement for any service or supply covered by the plan or cancel the coverage of an insured under the plan on the basis that: (a) The insured is a detainee; (b) The insured receives...”

• ORS Chapter 743A § 743A.250(2) (Emergency Eye Care Services)

  “Any insurer that offers a health benefit plan that provides coverage of eye care services shall allow any enrollee to receive covered eye care services on an emergency basis without first receiving a referral or prior authorization from a primary care provider. However, an insurer may require the...”

• ORS Chapter 743A § 743A.110 (Mastectomy-Related Services; Prior Authorization)

  “A health benefit plan must provide a single determination of prior authorization for all services related to a mastectomy covered under subsection (2) of this section that are part of the enrollee’s course or plan of treatment.”

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More Oregon sources

• ORS Chapter 746 - Trade Practices (selected Secs. 746.005-746.240)State statute
• Oregon Revised Statutes Chapter 742 - Insurance Policies Generally (152 sections, 742.001-742.710)State statute
• Oregon Revised Statutes Chapter 743 - Health and Life Insurance, first half (74 sections, 743.004-743.268)State statute
• Oregon Revised Statutes Chapter 743 - Health and Life Insurance, second half (116 sections, 743.269-743.826)State statute
• Oregon Revised Statutes Chapter 743B - Health Benefit Plans, first half (47 sections, 743B.001-743B.287)State statute
• Oregon Revised Statutes Chapter 743B - Health Benefit Plans, second half (50 sections, 743B.288-743B.810)State statute
• Oregon Revised Statutes Chapter 744 - Insurance Producers and Life Settlements, first half (60 sections, 744.052-744.367)State statute
• Oregon Revised Statutes Chapter 744 - Insurance Producers and Life Settlements, second half (86 sections, 744.369-744.994)State statute